Schuetz Audrey N, Guarner Jeannette, Packard Michelle M, Zaki Sherif R, Shehata Bahig M, Opreas-Ilies Gabriela
Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, New York, NY, USA.
Pediatr Dev Pathol. 2011 May-Jun;14(3):180-8. doi: 10.2350/10-04-0817-OA.1. Epub 2010 Nov 5.
Studies comparing placental pathology between human immunodeficiency virus (HIV)-positive and HIV-negative patients have shown conflicting results. In addition, few studies have evaluated the infectious etiology of placental inflammation in HIV-positive patients. We examined a cohort of placentas from 73 HIV-positive and 41 HIV-negative patients to gain a better understanding of the spectrum of placental inflammatory lesions. Bacterial and viral immunohistochemistry (IHC) was run on a subset of placentas (12 HIV-positive and 7 HIV-negative) with the greatest amount of inflammation. Although few histologic differences were seen between the HIV-positive and HIV-negative groups, chorioamnionitis was of a higher stage in the HIV-positive placentas. An infectious agent was found by IHC in 3 of 7 HIV-negative patients (2 Neisseria spp. and 1 group B Streptococcus ). One HIV-positive placenta showed gram-positive cocci on fetal membranes; organisms were not detected by IHC. In 2 patients, the etiologic agent was not suspected prior to IHC. This study identified that acute inflammation is less common in placentas from HIV-positive patients, compared with HIV-negative patients. However, when severe inflammation is present, infectious organisms may be identified by IHC, providing a more specific diagnosis and offering a beneficial impact in maternal and fetal management.
比较人类免疫缺陷病毒（HIV）阳性和HIV阴性患者胎盘病理学的研究结果相互矛盾。此外，很少有研究评估HIV阳性患者胎盘炎症的感染病因。我们检查了73例HIV阳性患者和41例HIV阴性患者的胎盘队列，以更好地了解胎盘炎症病变的范围。对炎症最严重的一部分胎盘（12例HIV阳性和7例HIV阴性）进行了细菌和病毒免疫组织化学（IHC）检测。虽然HIV阳性组和HIV阴性组之间在组织学上几乎没有差异，但HIV阳性胎盘的绒毛膜羊膜炎处于更高阶段。在7例HIV阴性患者中的3例（2例奈瑟菌属和1例B族链球菌）通过免疫组织化学检测发现了感染病原体。1例HIV阳性胎盘的胎膜上显示革兰氏阳性球菌；免疫组织化学未检测到病原体。在2例患者中，免疫组织化学检测前未怀疑病原体。这项研究表明，与HIV阴性患者相比，HIV阳性患者胎盘中急性炎症较少见。然而，当存在严重炎症时，免疫组织化学可能会识别出感染病原体，从而提供更具体的诊断，并对母婴管理产生有益影响。
